Casey Smiley, Jessica Rizzuto, Nicola White, Christina Fiske, Jennifer Thompson, Minhua Zhang, Ben Ereshefsky, Milner Staub
{"title":"大型学术医疗中心实施最新羊膜腔内感染指南","authors":"Casey Smiley, Jessica Rizzuto, Nicola White, Christina Fiske, Jennifer Thompson, Minhua Zhang, Ben Ereshefsky, Milner Staub","doi":"10.1093/ofid/ofae475","DOIUrl":null,"url":null,"abstract":"Background Intraamniotic infection (IAI) affects 2%–5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center. Methods Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression. Results After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by −2.5 DOT/1000PDP (95% CI, −3.8 to −1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change. Conclusions Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center\",\"authors\":\"Casey Smiley, Jessica Rizzuto, Nicola White, Christina Fiske, Jennifer Thompson, Minhua Zhang, Ben Ereshefsky, Milner Staub\",\"doi\":\"10.1093/ofid/ofae475\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background Intraamniotic infection (IAI) affects 2%–5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center. Methods Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression. Results After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by −2.5 DOT/1000PDP (95% CI, −3.8 to −1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change. Conclusions Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences.\",\"PeriodicalId\":19517,\"journal\":{\"name\":\"Open Forum Infectious Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofae475\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofae475","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center
Background Intraamniotic infection (IAI) affects 2%–5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center. Methods Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression. Results After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by −2.5 DOT/1000PDP (95% CI, −3.8 to −1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change. Conclusions Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences.
期刊介绍:
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.